to sleep or not to sleep… may 6 2010d. nesdoly md frcpc to sleep or not to sleep… consequences...
TRANSCRIPT
To Sleep or Not to Sleep…
To Sleep or Not to Sleep…
May 6 2010May 6 2010 D. Nesdoly MD FRCPCD. Nesdoly MD FRCPC
To Sleep or Not to Sleep…
To Sleep or Not to Sleep…
Consequences of Sleep Loss
Consequences of Sleep Loss
Scenarios
Scenarios
Scenarios
Scenarios01230123
0004
2400
04000149
0200
0645
Objectives
Objectives
Sleep Science historySleep Mechanics 101Sleep Deprivation ConsequencesShift-work risks ‘evidence’
Strategies Future research
Sleep Science historySleep Mechanics 101Sleep Deprivation ConsequencesShift-work risks ‘evidence’
Strategies Future research
Sleep Science History
Sleep Science History
1930 Berger- “Father of EEG”1937 Loomis- first overnight EEG human sleep recordings
1968 Standardized manual1974-Williams normative sleep data
2010-Accreditated Sleep Centers
1930 Berger- “Father of EEG”1937 Loomis- first overnight EEG human sleep recordings
1968 Standardized manual1974-Williams normative sleep data
2010-Accreditated Sleep Centers
Sleep BasicsSleep
Basics 3 Mechanisms ANS
PNS SNS
Homeostatic Sleep Drive
Circadian Sleep Rhythm
3 Mechanisms ANS
PNS SNS
Homeostatic Sleep Drive
Circadian Sleep Rhythm
Sleep StagesSleep Stages
Sleep StagesSleep Stages
Sleep StagesSleep Stages
Sleep WavesSleep Waves
Sleep Architecture
Sleep Architecture
Sleep Architecture
Sleep Architecture
Sleep Architecture
Sleep Architecture
ircaCircadian Sleep
DisordersCircadian Sleep
Disorders
Sleep Quantification
Sleep Quantification
ObjectiveMSLTMWTPVT
SubjectiveSleepiness scales
Stanford (1973 7 point)
Karolinska (1990 9 point)
Epworth (1991 situation-specific dozing likelihoods)
ObjectiveMSLTMWTPVT
SubjectiveSleepiness scales
Stanford (1973 7 point)
Karolinska (1990 9 point)
Epworth (1991 situation-specific dozing likelihoods)
Effects of Sleep Deprivation
Effects of Sleep Deprivation
Effects of Sleep Deprivation
Effects of Sleep Deprivation
Effects of Sleep Deprivation
Effects of Sleep Deprivation
Recovery Studies
Recovery Studies
Recovery Studies
Recovery Studies
Recovery Studies
Recovery Studies
Recovery Studies
Recovery Studies
Shift-work Syndrome
Shift-work Syndrome
Prevalence(U.S.-22 M SW +3% )Canada 11% rotating, 6% evening, 2% nights
Prototype Insomnia / Sleepiness Fatigue / Headache / Anxiety Indigestion / Pyrosis Hypertension Weight gain Menstrual irregularity / Sub-fertility / SA Depression Drowsy driving
Prevalence(U.S.-22 M SW +3% )Canada 11% rotating, 6% evening, 2% nights
Prototype Insomnia / Sleepiness Fatigue / Headache / Anxiety Indigestion / Pyrosis Hypertension Weight gain Menstrual irregularity / Sub-fertility / SA Depression Drowsy driving
Sleep Deprivation Impact
Sleep Deprivation Impact
IndividualFamilyCommunitySociety
IndividualFamilyCommunitySociety
Shift-work Impact
Shift-work Impact
Shift-work Impact
Shift-work Impact
Shift work + Cardiovascular Disease
Shift work + Cardiovascular Disease
Modest (+) associations w shift work (40%)
Causal link research inconsistent Daylight Saving Time *
Janszky (2008) Acute MI risk Mondays“Spring” Incidence ratio 1.051“Autumn” Incidence ratio 0.985
Modest (+) associations w shift work (40%)
Causal link research inconsistent Daylight Saving Time *
Janszky (2008) Acute MI risk Mondays“Spring” Incidence ratio 1.051“Autumn” Incidence ratio 0.985
Shift work (LAN) + Cancer
Shift work (LAN) + Cancer
Schernhammer (2001) Nurses Health Study Cohort240,000 women over 30 yearsControl for major risk factors, stress, SE statusCancer relative risk
Breast 36-79 %Colon 35%Endometrial 43%
2007 IARC classifies ‘night shift work’ as probable carcinogen (2A)
Schernhammer (2001) Nurses Health Study Cohort240,000 women over 30 yearsControl for major risk factors, stress, SE statusCancer relative risk
Breast 36-79 %Colon 35%Endometrial 43%
2007 IARC classifies ‘night shift work’ as probable carcinogen (2A)
Shift work (LAN) + Cancer
Shift work (LAN) + Cancer
Observational studies: modest (+) relationship b/w LAN + breast Ca
Pukkala (1995) Flight attendants > 15 YTynes (1996) Radio + telegraph operators
Prostate Ca Airline pilotsFirefightersHealth practitioners + physicians
Observational studies: modest (+) relationship b/w LAN + breast Ca
Pukkala (1995) Flight attendants > 15 YTynes (1996) Radio + telegraph operators
Prostate Ca Airline pilotsFirefightersHealth practitioners + physicians
Circadian Disruption Shift
work + Risk of Ca
Circadian Disruption Shift
work + Risk of CaSeattle Research group
LAN + Breast Ca Case control study60-Hz magnetic fields + nocturnal melatonin
Night shift work + biomarkersMelatonin + hormonesGenotypes (hCLOCK, Per2, Per3)
Seattle Research groupLAN + Breast Ca Case control study60-Hz magnetic fields + nocturnal melatonin
Night shift work + biomarkersMelatonin + hormonesGenotypes (hCLOCK, Per2, Per3)
Shift work + Pregnancy
Shift work + Pregnancy
Moderate (-) effect on fetal growthSGA / LBW
No association for pre-term delivery or pre-eclampsia
Moderate (-) effect on fetal growthSGA / LBW
No association for pre-term delivery or pre-eclampsia
Study Limitations
Study Limitations
Epidemiologic vs RCTSelection bias
“Survivor population” (entrance + drop-out)
Lower socioeconomic statusShift work definitionExposure measurement
Epidemiologic vs RCTSelection bias
“Survivor population” (entrance + drop-out)
Lower socioeconomic statusShift work definitionExposure measurement
Shift Work Proposed Mechanisms
Shift Work Proposed Mechanisms
Shift-work + Risk
Shift-work + Risk
Needle-stick eventsAyas (2006) Trinkoff (2007)
Clinical performanceHoward (2003)-AnesthesiaLockley (2004)-ICUSmith-Coggins (2006)-Emergency
Needle-stick eventsAyas (2006) Trinkoff (2007)
Clinical performanceHoward (2003)-AnesthesiaLockley (2004)-ICUSmith-Coggins (2006)-Emergency
Transportation Safety
Transportation Safety
Prototype ‘drowsy driver’Young male < 25Shift-workerUntreated sleep disorder (OSA / Narcolepsy)
Event 2400-0700Social Media: “Contagious”
Prototype ‘drowsy driver’Young male < 25Shift-workerUntreated sleep disorder (OSA / Narcolepsy)
Event 2400-0700Social Media: “Contagious”
Transport + Sleep Deprivation
Transport + Sleep Deprivation
CommercialTruckRailAir / ATC
Performance impairment = Ethanol intoxicationDawson 1997Powell 2001Vakulin 2007
CommercialTruckRailAir / ATC
Performance impairment = Ethanol intoxicationDawson 1997Powell 2001Vakulin 2007
Drowsy Driving Strategies
Drowsy Driving Strategies
AwarenessLegislationHighway rumble stripsOperator behavior
NapsCaffeineEnvironmental stimuli
AwarenessLegislationHighway rumble stripsOperator behavior
NapsCaffeineEnvironmental stimuli
Sleep Loss Countermeasures
Sleep Loss Countermeasures
PharmacologicNon-pharmacologic
PharmacologicNon-pharmacologic
Sleep Loss Countermeasures
Sleep Loss Countermeasures
PharmacologicAntihistaminesBenzodiazepinesNon-benzodiazepinesAntidepressants
Serotonin modulator SSRIS SNRI Tetracyclic Tricyclic
Melatonin receptor agonistAlternative
Valerian Kava Chamomile Synthetic melatonin
Non-pharmacologic
PharmacologicAntihistaminesBenzodiazepinesNon-benzodiazepinesAntidepressants
Serotonin modulator SSRIS SNRI Tetracyclic Tricyclic
Melatonin receptor agonistAlternative
Valerian Kava Chamomile Synthetic melatonin
Non-pharmacologic
Sleep Loss Countermeasures
Sleep Loss Countermeasures
PharmacologicNon-pharmacologic
BehaviouralSleep deprivationReconditioningRelaxation techniquesCBT
Schedule strategiesRestrict maximum 3 consecutive shifts
Forward shift rotationParticipatory approach
PharmacologicNon-pharmacologic
BehaviouralSleep deprivationReconditioningRelaxation techniquesCBT
Schedule strategiesRestrict maximum 3 consecutive shifts
Forward shift rotationParticipatory approach
Wolkove, N. et al. CMAJ 2007;176:1449-1454
Sleep Hygiene
Wolkove, N. et al. CMAJ 2007;176:1449-1454
Sleep Hygiene
Wolkove, N. et al. CMAJ 2007;176:1449-1454
Sleep Hygiene
Wolkove, N. et al. CMAJ 2007;176:1449-1454
Sleep Hygiene
Wolkove, N. et al. CMAJ 2007;176:1449-1454
Sleep Hygiene
Future ResearchFuture
Research
Common definitions (SW)Common assessment (exposures)
Study intermediate pathways vs disease outcomes
Outcome data NOT biomarkers
Common definitions (SW)Common assessment (exposures)
Study intermediate pathways vs disease outcomes
Outcome data NOT biomarkers
SummarySummary
Sleep science ‘101’Sleep debt awarenessSleep hygiene / ‘art’ of sleeping
Drowsy driving KILLS people
Sleep science ‘101’Sleep debt awarenessSleep hygiene / ‘art’ of sleeping
Drowsy driving KILLS people
Reference List
Reference List
Any Questions?
Erica
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